Parkland Memorial Hospital made “measurable progress” in March toward a massive reorganization aimed at protecting patients, according to the initial compliance report issued by safety monitors.

The report cautions that its scope is limited — it covers only a few days of preliminary work by Parkland to address more than 400 mandates outlined in a federally imposed action plan. Still, this is the monitors’ first upbeat assessment since issuing three scathing reports in February.

“We know we still have a lot of work to do to improve this health care system that is so important to our community,” Debbie Branson, chairwoman of Parkland’s governing board, said Monday. “But everyone from the boardroom to the emergency room is committed to improving patient safety and the quality of care.”

Dallas County Judge Clay Jenkins said he was encouraged by the report, the first in a series of monthly assessments.

“It took a long time to put the right pieces together to turn around Parkland, but the board, executive officers, leadership teams and monitors have built a solid plan and a capable team to execute that plan,” he said. “I expect to see objective improvements with each report card, and I am pleased the public will have access to that information.”

Quality-review report

Parkland has sought to keep all of the monitors’ reports secret. The Dallas Morning News obtained them with Freedom of Information Act requests to Medicare officials, who oversee the monitors. The Texas attorney general’s office has also ruled that the three February reports are public information.

One of those three reports, of Parkland’s quality-review process, is just now becoming public. It focuses on a key reason that patient safety failures have persisted at the Dallas institution: weak internal investigations by the Quality of Care department.

The report cited a patient death investigation that occurred in late 2011 or early 2012, while monitors were embedded in the hospital around the clock. The death followed administration of a narcotic — but the investigation “did not uncover the fact that the nurse administered drugs without a physician’s order.”

Monitors repeatedly intervened to ensure that matters were thoroughly investigated, the quality-review report says. They “raised our concerns to the hospital’s senior leadership in some cases, strongly recommending that a second review occur or that additional evidence should be considered.”

The flawed inquiry into the death is symptomatic of a broader collapse of quality controls, the report says. Among its other findings:

Events in which patients are harmed “are too often viewed as isolated incidents, rather than symptoms of a systemic problem.”

Investigations frequently “are not conducted or completed in a timely manner.” The delays “result in fact-gathering errors” and “mean that unsafe practices may be continuing.”

Quality department employees sometimes delete safety reports if more than one caregiver writes up the same event. “Vital information has been lost.”

The department has more than 60 employees and “is more than adequately resourced with personnel.”

Daunting task

Jenkins said the quality-review report was “concerning” and demonstrates how daunting Parkland’s task is in establishing patient safety controls. He has been deeply involved in efforts to develop a contingency plan in case the hospital is forced to close or scale back operations.

Parkland is entering its sixth month under a rare federal oversight program after inspections last summer found that it was jeopardizing patients’ safety. Breakdowns included lax infection control and substandard emergency care. Last fall, the U.S. Centers for Medicare & Medicaid Services forced the hospital to hire Alvarez & Marsal Healthcare Industry Group as onsite safety monitors.

After almost three months at Parkland, the monitors completed a report in early February saying that severe problems remained throughout the hospital. It was given until April 2013 to prove it could comply with federal regulations. Failure will lead to termination of hundreds of millions in federal funds Parkland needs to operate, regulators have warned.

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